Rajesh, Joseph Selvakumar (2013) A Case Control study of Lipoprotein a levels in patients with Atherosclerotic Peripheral Arterial Occlusive disease. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Peripheral arterial occlusive disease (PAOD) is a major contributor to hospitalisations to any Vascular Surgery Unit, worldwide. The prevalence of PAOD is on the rise around the world; more alarmingly among developing nations like ours. The majority of hospitalisations (both diagnostic and therapeutic) for lower limb arterial insufficiency worldwide are linked to PAOD. Since the current standard of care for atherosclerotic PAOD involves a multimodality approach of risk factor reduction by life style modification, medications and interventions which include surgical and endovascular repairs, the financial burden of this disease is immense. The risk factor profile for atherosclerotic PAOD encompasses the traditional risk factors associated with cardiac atherosclerotic vascular disease, which include age, smoking, dyslipidemia, diabetes mellitus and hypertension. Studies have demonstrated an association with elevated Lp (a) and cardiac atherosclerosis. Lp (a) accelerates atherosclerosis at various levels; starting from increased endocytosis of VLDL by macrophages in the arterial wall, to inhibiting clot lysis. Recent data from studies done in an Indian population corroborates the above; demonstrating a correlation between elevated Lp (a) levels and CAD. Based on this information, therapeutic measures to lower Lp (a) levels have been demonstrated to improve outcomes in coronary artery disease. Since atherosclerotic PAOD shares the same risk factor profile as CAD, it is hypothesized that Lp(a) levels may be elevated in atherosclerotic PAOD patients. OBJECTIVE: To determine the proportion of patients with atherosclerotic peripheral arterial occlusive disease (PAOD) who have elevated Lipoprotein (a) [Lp (a)] levels. METHODS: This was a prospective, non-randomized, case-control study conducted among patients who presented with symptomatic atherosclerotic peripheral arterial occlusive disease. Informed consent was taken for the cases and controls and the patients were subjected to a fasting blood sample of serum Lipoprotein a which was analysed in the Biochemistry laboratory. RESULTS: Elevated Lp (a) levels were found in 89.1% of the cases as opposed to 54.5% of the control population with an odds ratio of 6.8 with a p value of <0.001(95% CI 2.5-18.5). The type of presentation did not correlate with elevated Lp (a) levels. Other atherosclerotic risk factors did not have a statistically significant effect on Lp (a) levels suggesting that Lp (a) was an independent risk factor leading to the development of PAOD. CONCLUSIONS: 1. There was an elevated level of Lp (a) in both cases and controls. 2. The elevated level was more significant in cases than in controls. 3. Among the atherosclerotic risk factors only hypertension correlated with an increase in Lp (a) levels. 4. More data needs to be collected to ascertain the normal level of Lp(a) in the Indian population. 5. Randomised control trials need to be carried out to assess the effect on Lp (a) lowering therapy on patients with PAOD.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Lipoprotein ; Atherosclerotic Peripheral Arterial Occlusive disease ; Case Control study. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 04 May 2018 04:14 |
| Last Modified: | 04 May 2018 06:14 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7436 |
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